PRK: Final Assessment and Grade Assignment

The results have been solid long enough to draw a conclusion: My left eye is pretty good. The right eye is a little low-powered. When I get up in the AM, I see fine. As the day wears on, they both decline a little. The end result, though, is that the right eye brings down the combined vision quite a bit. Squinting is normal. The final checkup at the eye center said that my eyes were 20/20 (left) and 20/20 right, but I don't see how that's possible when my right eye is noticeably weaker. I guess if you get one letter on the 20/20 line, it counts for 5? 20% is passing nowadays? Glad I"m not in school anymore.

Well, the doc and I had a sit down and did some number crunching. He says that re-touching the right eye is possible, but that the laser has a +/- .5 diopter variance and that it's possible to overshoot and make the right eye +.5 farsighted which would mess up the intermediary distances. His summary "if it's not a clear choice, don't make a choice." He offered to re-measure my eyes in 6 months, but I am not sure what that will get us.
I also asked about why I see less well in flourescent lights and low lights? The sub-doctor believes that this is b/c there is some necessary scarring that occurs when the laser cuts and this may be refracting light although this may not be noticeable during high daylight when the amount of light available makes the small amount of lost light unnoticeable.

Final summary: I'd give my final results a 92 or 93.

Pros:
Before I was near blind without my contact whether day or night or twilight. Now I can see well enough to do most everything a modern man would be required to do w/out contacts: work on a pc, drive during daylight hours 100%, read books, newspapers, etc. The TSA won't have to worry about my bottles of saline as I pass through airport security ever again.

Cons:
There is some difficults distinguishing contrasts between forms at twighlight or in low-light scenarios, including flourescent-lit rooms. This matters to me, as I hunt and well, those pesky elk don't like to get out of dark timber much except early AM or early PM. Night driving is a little difficult in areas where I'm not familiar, b/c the weaker right eye makes reading street signs from a distance very difficult. Also, the loss of vision b/c of the scarring in low light environments means that items on the perifery of my headlights (pedestrians, animals, etc) aren't as apparent.

I would probably still have the PRK surgery done, if I were offered a chance to do this again. I would definitely choose to do the eyes one at a time, if I were going to do the surgery.
Thanks for reading, good luck.

ac

Sign out, maybe

I'm about 3 months in now. The eyes are both pretty steady. I still see excellently in the AM, but much weaker late in the day. Flourescent lighting is a problem. Working on a PC still tires them, probably b/c I am older.
In general, I am happy with the way this turned out. Still, I am considering having one of my eyes, probably the right, "tuned" as it is a hair weaker than my left. Both are a little bit under-tuned. I understand this theory of conservative cutting and I don't disagree with it, but the right is a hair more off, so there might be room for improvement there. If I stop now, I would still be happy. Driving at night in the rain can be less than ideal, but not so much so that I feel like I'm endangering anyone.

But today, my daughter accidentally poked me in the eye while dressing. It was quite a jab and her finger actually got up under my eyelid a bit. At the very least, I'm completely happy with my choice to do PRK over lasik.

5/7 week update

did my checkup and luckily, I had very dry eyes when I did this last friday. I say luckily, b/c now I know what my eye strength is towards the end of the day when things go south. I am -.3 in one eye and -.5 in the other. The Doctor told me that this was not all bad, as being slightly nearsighted would be a way to buffer the onset of wearing glasses as my eyes gravitated to farsightedness. I didn't buy that. A couple alternatives were floated. 1. keep the eyes wetter, since the vision is good in the AM and probably things wear out later. 2. wear light-prescription glasses later in the day. I scuttled #2 immediately, as the goal here is to NOT wear glasses.
We discussed re-cuts. I asked the Dr. what the percentage of success/failure (overshoot or undershoot) was for this particular establishment on 2nd cuts. She didn't know but would ask. OK. I'm probably not going to worry about the -.3 eye. The -.5 would be the fixer-up-er. I still have a little ghosting that comes and goes with wetness/blinking. I"m not terribly concerned either way yet; I am minorly inconvenienced by my level of nearsightedness where previously I was unable to function w/out glasses. If we stopped where we are, I would probably have better vision than 90% of the world's population through history.
I would probably have to take some drops into the field with me when camping or elk hunting, but since I wouldn't be looking at a computer screen all day, I expect my vision would actually be better outdoors.
Next checkup in 6 months. The ghosting/dry eyeness *should* be gone by then. The head doctor should call to talk about options next week or so.

Tidbits I picked up

I picked some info during the checkup on Friday. First of all, the eye sight is doing well. somewhere around 20/25 combined. My doc says I'm on the high edge of the recovery curve and that it usually takes longer. FYI: this was my 5/3 week checkup.

Some Answers:
A: why do I see best in the first 30-60 mins of the AM? 1. B/c I use a computer, my eye lenses don't focus far and like lifting a weight. It's easy at first, but gets harder as the day progresses. I was recommended to take several breaks from work each hour and stare at some object in the far distance. Also, keep the eyes wet. B/c my eyes aren't used to focusing this far on their own, since they had help in the past, this will need to be worked on. never knew there was rehab involved, but I guess I will work on this. They are the doctors.

B. Why do I see better on some days than others. Answer: depends on the daily amount of swelling. As a general curve, the eye swelling should be decreasing over time. Therefore the amount of variance in my daily vision should reduce over time, but some days the eyes will be more swollen than others.

Update 3/5

3 week semi-versary for the left eye; 5 weeks for right.
the combined vision is pretty good today.
If it were yesterday, I would have given the results a C. Today, I would say B. It's weird that the vision is a little better out of my left eye than my right. But. combo is solid today.
Unstable is the new stable.

Check up tomorrow at the doc's office will be able to put numbers with the results.

Unstable is the new Stable

My last blog from Saturday the 28th was very positive. If I had written a blog on Sunday, it would have been much more negative. Monday was more promising than Sunday, but less than Saturday. In general, each day gets better, but they all follow a similar pattern. I wake up. I can see well. I look across the field across from our house and I can pick out the individual slats in the rail fence about 250 yards away. I can see the Continental divide very clearly. At some point in the next hour, perhaps b/c of the cup of coffee I drink (I don't know), my vision degrades to pretty good. I can read my PC okay while working. Eventually, though, it fades out. Last night we went to a pro hockey game and I had lost a goodly amount of detail toward the end.
Today, the vision was pretty good. The 2 week semaniversary is tomorrow for the left eye. I can see pretty well. I suspect that the period of improvement in my vision in the first part of the day will become longer as the eyes heal.

I poked myself in the eye today b/c I fell back into my habit of adjusting dried contacts by hand.

Back on the Bike

Right eye:85% or so. Left eye: 60%. Combo: 90%. Good enough to get out and ride a bike in a group. After 4 weeks of no riding, it's good to start returning to normal life. I take eye drops with me and re-wet my eyes a couple times each ride. Recovery is over the hump and I would consider my 7-10 day forecast for viable vision with a reworked right and a newly lasered left to be on schedule.

No contact, no foul

I removed my last contact today. yeah. I read on other blogs that taking out a contact results in a short time of back-tracking. I haven't noticed this, but this might be another advantage of the one-at-a-time technique--the right eye has been covering for the left for so long that if it is a little weaker, the overall visual picture quality remains the same.
Or it could be that after getting 5 hours of sleep in the last 72 hours, my vision is just monumentally messed up all around and can't get any worse. I dunno.

Almost 1 week on (two)

I am almost done with a week since having my second eye done. Apologies for the delay in posting, but real life has intervened. I am on the road. In fact, I left on Tuesday and missed the normal day for meeting with an eye doc to remove the "bandage" contact from my left eye. The eye stopped hurting on Saturday about noon. There is a still some hazing in the eye but not as much as in the first several days. Not sure how much of the hazing is from the contact. I'm betting not much since it's less now that the contact has been in for 6 days. The doctor has given me license to remove the bandage contact myself on Thursday. I will probably do this in the AM. I am doing my second consecutive midnight-5 am tech gig and will probably remove the contact after getting a brief nap this coming morning.
On the positive side. I have been driving (mostly during the day) and this has gone well. Street signs are difficult, but speed limits, warning signs, etc are pretty visible and becoming more so. I still have the font size pumped up on my PC and Blackberry, but it's not absolutely necessary. Summary: I think that a 3 week wait would be the bare minimum for "hitless" PRK eye surgery. 4 weeks would be probably 95% chance of being completely smooth. Going at 2 weeks was a little early, but my guess that this will be completely workable at day 10 or so (4 days out, I hope!) . My working definition is of workable is "having a level of vision that is solid enough that I don't consciously think about it as I read, drive, etc" However, I am not sure that will happen even if I can read well. My right eye is seeing well enough that I find myself thinking that I should remove the contact from my eye before I go to bed. It's a good problem to have.

Followup

Doctor did follow up on my today. Left eye is "progressing normally" if by normal you mean red and swollen. The right eye is at a nominal 20/25 today although it's kind of blurry and watery b/c the left is blurry and watery. Still, I am cautiously optimistic that this will turn out okay. The right eye is pretty hazy right now.
Big twist: I am traveling for work next week from tuesday morning to friday. This has thrown the doctor's time schedule into a little bit of a conundrum. No docs are in the office on Monday and I am flying out at 10 am. If Dr. Beyer bends his schedule to see me Monday/Tuesday, I will feel obligated to clean, fix his bike for free.

Keeping its promise (to whoop my butt)

My left eye feels as though someone threw a bucket of sand in it. It's red as an apple and completely unhappy. I am holding off on the pain-killng drops that I have been given until the doc can see me for a follow up today. Instead, I packed a fingerful of that goopy night-time Refresh lube into the eye and taped it shut with a sterile pad over it. That's some relief.
The good news is that while it was uncovered this AM, it appears that my vision is borderline 20/20 (the left eye is still not near 100%). I am thinking that, as Dante related long ago, there is only ascent through purgatory, although the journey is hard all the way.

This nasty little turn makes me even happier that I am doing my eyes one at a time.

Pain/Irritation Factor Scorecard:
One Eye: Bad Enough
Both Eyes at once: Debilitating.

Hope everyone has a good weekend! I'll be hanging out with my cold pad and watching the Tour of California.

Post OP

The left eye promises to be a wholey different experience.
1. The doc took noticably more time to lase the left eye. It began to hurt almost immediately after I got home.
2. Valium (say it: it sounds a lot like "Newman!")
I hate Vaium. It is now my personal enemy. I don't remember being this groggy after the valium hit for the right eye.

conversely, the view has imporoved. Maybe this is b/c I have jacked up the size of the fonts I use, but I also think that the brain works harder on the image coming to the right eye since it is dominant.

I will be traveling for work for most of next week. We will see how the contact bandage works after a week, this time!

Week 2 summary.

The right eye is coming along. As mentioned in other blogs, the eye works better in the AM than in the PM. I believe this is b/c the eye lid puts pressure on the eye ball overnight and that I notice the better vision as the new cells grow in first thing in the AM. Probably the new cells dry out by the end of the day, and the eye expands a tad to reduce the gains. My theory;completely unscientific.
So how am I seeing? I see okay. I can see the back-lit letters on the PC ok with my corrected eye. Not perfect. There's ghosting. I would expect that if I waiting another week or two, that the switch from left eye patched to right eye covered would be seamless, but I'm getting impatient.
I do notice from using the patch how much the brain seems to rely on combining the input from both eyes. I figure that the beauty of doing both eyes is that the brain can make a pretty decent picture from both recovering eyes after about 10 days. So, I am gambling that I will be fully functional after about 7-10 days and will have saved a week or two of waiting.

14 days in:
Patience factor: 2 eyes: 1 1 eye-at-a-time: 0

Week 1 belated summary

At the end of the first week, I think that a person who did both eyes would be pretty functional. If you look at any item and cover each eye in turn, you notice that you never see as well with one eye as with two. I still see some ghosting and hazing from the PRK in my right eye. My left is 100% clear, of course. The interesting turn over the past day or so is that I can't wear my glasses for extended periods and then just drop my patch and compare my "new" eye and my corrected "old" eye. even though the new eye sees pretty clearly at those times, I get a strain--like when I look through my wife's glasses which accomodate astigmatism. Everything is clear, but just a little off. I think it's because the brain sort of "calibrates" to a certain size image and then cannot adjust to the immediate input from a an eye not wearing glassses. I tested this theory this AM. I woke up and wore no glasses and did fine. So I'm guessing that the calibrating resets over night. There's all sorts of cool experiments one could do with patches and brain functions. Hopefully, most have already been done.
The left eye is scheduled for 10 days from now. Hope that I don't get blind-sided from the right while driving before then.

ac

On the road again

Business trip to Sprint in Kansas City. Mid PM my eye began hurting. I think that some of the people in the conference room thought I was winking at them...
My first "bad" day in which I had prolonged irritation.
I'm not sure if I had an eyelash under my eyelid or a problem with my eye now that the contact is out. Maybe the plane ride dried out my eye; will make sure to use more liquid next tomorrow. Off and on better through the day. The vision appears to get better and worse.
Watched US beat Mexico in world cup qualifying today. Maybe it was the surgery, but the US appeared to be playing at 1/2 speed.... Has the US team always been this out of sync?

And off goes the contact!!

Hopefully, this bandage contact will be the last contact I will ever have in my right eye.
The contact was taken by a different doctor, not the man whose name is on the clinic. He and I had a quick philosophical discussion about why I chose to do one eye at a time. Then Dr. Beyer came in. He and I chatted about how my eye was doing (fine, no pain) and he remarked that it's completely subjective and that some people are reduced to tears (even super-athletes) while other are completely non-plussed about the experience. I am very definitely on team pluss-less.

As a matter of fact, I tried to reschedule my second eye from 2/26 to 2/19, but the date was full, although they will call if an opening comes up. Apparently, the recession hasn't slowed down the eye-fixing industry. I will get my left eye done on 2/24 instead.


expect more boring posts until 2/24.

ac

Day 6: Tuesday 2/10/09

They eye is coming along. From our house, we have a pretty nice view of the continental divide (ok, it's really about 40 miles away, but when it's still visible, who's counting?). I can make out some nice details amidst the recovery haze. I expect that my right eye will be pretty good when this is all said and done. I find myself looking more and more at camping gear on the Cabela's website....
No pain or itching whatsoever.
today I get the bandage contact removed. My vision is supposed to regress for a brief time after that happens. kind of a bummer to consider, but if my eyes continue to improve at this rate, I will move up the date for my second eye by a week.
More after the doc's appointment this PM.

Day 5:Monday

Snoozin'. No pain. No itching. Someone in another blog reported that seeing out of an eye that is healing after PRK surgery is like "looking through a sheet of plastic." That's about spot on.
Otherwise, I wore the patch and I drove myself 50+ miles to a customer site today and am working on a PC as though all is normal.
Score:
Real Life 3
PRK inconvenience 0

Sorry, that there's not more to write, but there's no drama here yet. Tomorrow I get the contact bandage out, so we can look forward to some "woe is me" whining then.

Day 3/4: It's Sunday, do you know where your eye drops are?

Sunday was supposed to be the big bad day--the nadir of my recovery. My eye was a little itchy this AM, but hasn't been for the past several hours. If I kept the eye closed, the itching seemed to go ease. I can't imagine having both eyes itching at once. I did the 3 AM goop reload last night, so my eye is being pretty well hydrated all the time-- maybe that's helping. I also took a nap yesterday afternoon with my right eyecup buried in a cold compress for an hour.
My wife tells me that I often squint with my left eye when I am looking at my PC. Ok.
Also, I won't be able to join my cycling team on any group rides until I get stereo vision back. I might ride solo for awhile, so my fitness doesn't fall too far behind.

Night 2: still no pain

Wore the shields, re-lubed when I got up to take a nature break at 5. No issues. I went out last night to check the mail. It was 10 or 11 pm. The 2/3 waxing moon was up and there was lots of light. I took off my patch to see just how big and bad the halos would be around car lights or street lights. The halos were about 50% bigger and definitely thicker than the same types of halos you see when driving at night w/dried out contacts. FYI.
One thing that is a very cool side effect--your recovering eye is very light sensitive. During the day this translates to watering and pain (AND POTENTIAL SCARRING BY UV RADIATION!!), if you don't shield it. At night, dude you can see like a cat!! Okay, I suspect that cats can see a little better, but when I held my hand in front of alternate eyes, I could see light and shadows with my unfixed eye, but I could see like it was day AND into the shadows like they weren't there with my lasered eye. Someone needs to figure out how to make this happen w/out the laser work.
Ok, more on day 3 later. Theoretically, the ride should be getting rough today. I am in no pain, but I am taking preventative measures and holding frozen veggies over my eye this AM while drinking coffee.

Take your eye drops.
Grappa is divine.
That is all.

Day 2b: doctor checkup

Another win for one-eye methodology: I drove myself to/from my checkup on day after PRK. Small victories and independence allows one to put up with more difficulties, I think.

All looks good according to the medical professionals. They recommend that I spend a little more time with my eye closed under my eye patch.
The PRKpirate says "Aye, Cap'n"!

The saw bones say that my vision will be going downhill while my cornea heals (um, no-kay) and my vision will regress a little while after the clear contact bandage is removed. Whatever, this is a one-way trip, so there's no sense getting geeked up about the rapids ahead.

Day 2

Woke up this AM at 3:30 to download a little hydration data. My right eye was a bit sticky and dryish, although not painful. I had put into my eye some Refresh PM overnight moisture
and appeared to be wearing out. So I washed my hands and put another scoop of goop in. slept like a baby.
Speaking of which, my one-eye at a time choice has born immediate, if smelly fruit. My child has gotten sick and puked all over me not 3 seconds after I had put my morning steroid, anti-inflammatory, refresher and whatever else drops in. I had to help clean her up and change her and the house. Couldn't have done that with no vision.
Still only occasional twinges of "eyelash itch" in my right eye. However, I use the lub drips pretty liberally. The doctor's reference guide says "once an hour." I do it whenever it seems necessary. Since it's over the counter stuff w/no medicinal value or side effects (I use Refresh liquigel), I am going to restock as needed and screw the cost. I just blew $2K getting one eye fixed up. What's another $10 or $20 bucks?
I wore swim goggles when taking my AM shower.
My vision in my right eye is probably 80%, but I am not out from under the patch that often. I think I'm doing pretty well. Will see what doc's follow up checkup says. Supposedly, days 3-5 are the roughest, so I expect this to get more unconfortable no matter how much liquid I put in my eye. I guess it's like falling w/out a parachute: the first 15,000 feet is really okay, it's the last 6 inches or so, that times get tough.

Intro--Statement of Cyclopean Purpose

When I decided to get laser corrective surgery, there were really only 2 choices-- LASIK, the 800 lb gorilla, and PRK, the latest evolution of the original method, RK; this is now mainly considered a second option. I chose PRK b/c I think I am willing to suffer through a little more pain up front than have to worry about loosening (or losing!!!) my LASIK flap at some point later in life b/c of eye trauma. You can research the pros and cons of each methodology on many other websites. After I decided on PRK, I did a fair amount of research on the WEB looking over people's experiences in PRK recovery. Most of these bloggers elected to have both eyes corrected via PRK on the same day.
Insert short rant by AC:
Some eye shops apparently don't "offer" a choice to do one eye at a time. They often "recommend" you do both. Hey, it's your eyes: ASK!! Since you are being charged on a per-eye basis, having to do 2 follow-ups, 2 surgeries, etc., shouldn't be an issue for the doctors' office. If they are a simple "chop shop" that wants to get you finished (and billed) ASAP, go somewhere else. They don't care about you, so return the favor rather than carry a regret later.
End rant by AC.
I decided to do one at a time. There are several reasons that I chose this path. The cool pirate patch was not one of them.
1. I hate being functionally disabled for any reason for any length of time.
2. I'm doing this elective surgery to rid myself of the dysfunctional support of contacts and glasses for this reason--being incapacitated for a weekend defeats the purpose.
3. I have a wife and a child and I can't be out of commission. If, God forbid, something happened that required that I drive to the ER at 12 AM, I need to be able to function. This is something that I'm doing by choice, so I choose to not impinge on other people's mercies and schedules where not required.
4. I don't have a week of vacation time to use. And if I did have excess vacation time, I still wouldn't burn it sitting in bed with cold compresses on my eyes.
5. I am 40. If I waiting this long to do something about this, then I can wait another 3 weeks to get the second eye done.

Most of the PRK blogs that I read seem to fall into a bell curve where eye functionality is pretty good after 3 weeks of recovery. My gamble here is that I will be well enough after 3 weeks that I can get the opposite eye corrected and the original target of surgery will be strong enough to "get 'er done." We will find out together if this works.